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Quigley RM, Kearney M, Kennedy OD, Duncan HF. Tissue engineering approaches for dental pulp regeneration: The development of novel bioactive materials using pharmacological epigenetic inhibitors. Bioact Mater 2024; 40:182-211. [PMID: 38966600 PMCID: PMC11223092 DOI: 10.1016/j.bioactmat.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
The drive for minimally invasive endodontic treatment strategies has shifted focus from technically complex and destructive root canal treatments towards more conservative vital pulp treatment. However, novel approaches to maintaining dental pulp vitality after disease or trauma will require the development of innovative, biologically-driven regenerative medicine strategies. For example, cell-homing and cell-based therapies have recently been developed in vitro and trialled in preclinical models to study dental pulp regeneration. These approaches utilise natural and synthetic scaffolds that can deliver a range of bioactive pharmacological epigenetic modulators (HDACis, DNMTis, and ncRNAs), which are cost-effective and easily applied to stimulate pulp tissue regrowth. Unfortunately, many biological factors hinder the clinical development of regenerative therapies, including a lack of blood supply and poor infection control in the necrotic root canal system. Additional challenges include a need for clinically relevant models and manufacturing challenges such as scalability, cost concerns, and regulatory issues. This review will describe the current state of bioactive-biomaterial/scaffold-based engineering strategies to stimulate dentine-pulp regeneration, explicitly focusing on epigenetic modulators and therapeutic pharmacological inhibition. It will highlight the components of dental pulp regenerative approaches, describe their current limitations, and offer suggestions for the effective translation of novel epigenetic-laden bioactive materials for innovative therapeutics.
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Affiliation(s)
- Ross M. Quigley
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin (TCD), University of Dublin, Lincoln Place, Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, and Tissue Engineering Research Group, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Michaela Kearney
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin (TCD), University of Dublin, Lincoln Place, Dublin, Ireland
| | - Oran D. Kennedy
- Department of Anatomy and Regenerative Medicine, and Tissue Engineering Research Group, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- The Trinity Centre for Biomedical Engineering (TCBE) and the Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland (RCSI) and Trinity College Dublin (TCD), Dublin, Ireland
| | - Henry F. Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin (TCD), University of Dublin, Lincoln Place, Dublin, Ireland
- The Trinity Centre for Biomedical Engineering (TCBE) and the Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland (RCSI) and Trinity College Dublin (TCD), Dublin, Ireland
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2
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Li XL, Fan W, Fan B. Dental pulp regeneration strategies: A review of status quo and recent advances. Bioact Mater 2024; 38:258-275. [PMID: 38745589 PMCID: PMC11090883 DOI: 10.1016/j.bioactmat.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/18/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
Microorganisms, physical factors such as temperature or mechanical injury, and chemical factors such as free monomers from composite resin are the main causes of dental pulp diseases. Current clinical treatment methods for pulp diseases include the root canal therapy, vital pulp therapy and regenerative endodontic therapy. Regenerative endodontic therapy serves the purpose of inducing the regeneration of new functional pulp tissues through autologous revascularization or pulp tissue engineering. This article first discusses the current clinical methods and reviews strategies as well as the research outcomes regarding the pulp regeneration. Then the in vivo models, the prospects and challenges for regenerative endodontic therapy were further discussed.
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Affiliation(s)
- Xin-Lu Li
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, 430079, Wuhan, China
| | - Wei Fan
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, 430079, Wuhan, China
| | - Bing Fan
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, 430079, Wuhan, China
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Kong X, Vishwanath V, Neelakantan P, Ye Z. Harnessing antimicrobial peptides in endodontics. Int Endod J 2024; 57:815-840. [PMID: 38441321 DOI: 10.1111/iej.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 06/13/2024]
Abstract
Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad-spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments.
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Affiliation(s)
- Xinzi Kong
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Vijetha Vishwanath
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Prasanna Neelakantan
- Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
| | - Zhou Ye
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
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Leveque M, Guittat M, Thivichon-Prince B, Reuzeau A, Eveillard M, Faure M, Farges JC, Richert R, Bekhouche M, Ducret M. Next generation antibacterial strategies for regenerative endodontic procedures: A scoping review. Int Endod J 2024; 57:804-814. [PMID: 37485747 DOI: 10.1111/iej.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The clinical results following regenerative endodontic procedures (REPs) vary according to numerous parameters, including the presence of bacteria. This limitation reduces the indications for REPs and calls for the development of next generation antibacterial strategies (NGAS) providing alternatives to current antibacterial strategies (CAS) such as double or triple antibiotic paste (DAP/TAP) and (Ca(OH)2). OBJECTIVES The present scoping review aims to describe the current trends regarding the use of such strategies and highlight future perspectives. METHODS Four databases (PUBMed, Cochrane, ClinicalTrials and Science Direct) were searched until 1st May 2023. RESULTS A total of 918 records were identified, 133 were screened and assessed for eligibility, and 87 articles were included. The findings show that (1) clinical studies are only available for CAS, (2) although next generation strategies are the most studied approach since 2017, they are all at the pre-clinical stage, (3) most of the next generation strategies use galenic forms which offer cell support and colonization and which simultaneously contain antibacterial molecules as alternatives to CAS and to antibiotics in general, (4) standardization is required for future research, specifically regarding the bacterial strains studied, the use of biofilm studies and the cellular behaviour assessments. CONCLUSION Although NGAS are promising strategies to improve REPs in the context of infection, the current evidence is mostly limited to pre-clinical studies. Further methodological improvement is required to allow relevant comparisons between studies and to reduce the time from bench to bedside.
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Affiliation(s)
- Marianne Leveque
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Guittat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Béatrice Thivichon-Prince
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Alicia Reuzeau
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Matthieu Eveillard
- Département de Biologie des Agents Infectieux, CHU Angers, Angers, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France
| | - Marjorie Faure
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Raphaël Richert
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Mécanique Des Contacts et Structures, CNRS/INSA, Villeurbanne, France
| | - Mourad Bekhouche
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
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5
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Ribeiro VMDS, Sousa MGDC, Garcia PR, Santos LSD, Duarte ECB, Corrêa JR, Labate CA, Cataldi TR, da Costa RA, Ramada MHS, de Carvalho JL, Rezende TMB. Histologic and proteomic profile of two methods to decellularize human dental pulp tissue. Arch Oral Biol 2024; 157:105847. [PMID: 38000129 DOI: 10.1016/j.archoralbio.2023.105847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE The present study compared the structural and proteomic architecture of extracellular matrices (ECM) of decellularized human dental pulp using two previously described protocols. DESIGN Pulp tissue from 150 molars was extracted and three treatments took place, based on the Matoug-Elwerfelli Group (MG) and the Song Group (SG) protocols and an untreated pulp group (CG), to examine histoarchitecture and the effectiveness of the decellularization process, using histological analysis (n = 12) and scanning electron microscopy (SEM) (n = 3). Protein extraction took place using 100 mg dry weight of pulp, in triplicates for each group, and the shotgun proteome analysis was performed by nanoUPLC-MSE. Proteins were identified using the revised human UNIPROT database attached to the PLGS search engine. RESULTS Histological analysis and SEM demonstrated that ECM in MG was more preserved. Proteome analysis showed that the decellularized process in MG maintained approximately 69.56% of proteins identified in untreated pulp tissue while SG maintained 28.26%. CONCLUSIONS ECM appears to be suitable as a potential biological scaffold for pulp revascularization and regeneration procedures, especially those processed according to the Matoug-Elwerfelli protocol. This finding can collaborate to enhance clinical solutions for young permanent teeth that have suffered necrosis.
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Affiliation(s)
| | - Maurício Gonçalves da Costa Sousa
- Knight Cancer Precision Biofabrication Hub, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States; Cancer Early Detection Advanced Research Center, Oregon Health and Science University, Portland, OR, United States; Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, United States
| | - Paula Ribeiro Garcia
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil; Departamento de Clínica Odontológica, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Lucas Souza Dos Santos
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | | | - José Raimundo Corrêa
- Decanato de Ensino de Graduação, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Carlos Alberto Labate
- Laboratório Max Feffer de Genética de Plantas, Departamento de Genética, Escola Superior de Agricultura Luiz de Queiroz, Universidade de São Paulo, Piracicaba, Brazil
| | - Thaís Regiani Cataldi
- Laboratório Max Feffer de Genética de Plantas, Departamento de Genética, Escola Superior de Agricultura Luiz de Queiroz, Universidade de São Paulo, Piracicaba, Brazil
| | - Rosiane Andrade da Costa
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Marcelo Henrique Soller Ramada
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Juliana Lott de Carvalho
- Curso de Medicina, Universidade de Brasília, Brasília, Distrito Federal, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Taia Maria Berto Rezende
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil; Departamento de Odontologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil; Programa de Pós-Graduação em Odontologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
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6
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Xu H, Liu Z, Wei Y, Hu Y, Zhao L, Wang L, Liang Z, Lian X, Chen W, Wang J, Yu Z, Ma X, Huang D. Complexation-Induced Resolution Enhancement Pleiotropic Small Diameter Vascular Constructs with Superior Antibacterial and Angiogenesis Properties. Adv Healthc Mater 2023; 12:e2301809. [PMID: 37571957 DOI: 10.1002/adhm.202301809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/05/2023] [Indexed: 08/13/2023]
Abstract
3D printing has been widely applied for preparing artificial blood vessels, which will bring innovation to cardiovascular disorder intervention. However, the printing resolution and anti-infection properties of small-diameter vessels (Φ < 6 mm) have been challenging in 3D printing. The primary objective of this research is to design a novel coaxial 3D-printing postprocessing method for preparing small-size blood vessels with improved antibacterial and angiogenesis properties. The coaxial printing resolution can be more conveniently improved. Negatively charged polyvinyl alcohol (PVA) and alginate (Alg) interpenetrating networks artificial vessels are immersed in positively charged chitosan (CTS) solution. Rapid dimensional shrinkage takes place on its outer surface through electrostatic interactions. The maximum shrinkage size of wall thickness can reach 61.2%. The vessels demonstrate strong antibacterial properties against Escherichia coli (98.8 ± 0.5%) and Staphylococcus aureus (97.6 ± 1.4%). In rat dorsal skin grafting experiments, Cu2+ can promote angiogenesis by regulating hypoxia-inducible factor-1 pathway. No artificial blood vessel blockage occurs after 5 days of blood circulation in vitro.
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Affiliation(s)
- Huilun Xu
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
| | - Zhengjiang Liu
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
| | - Yan Wei
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Yinchun Hu
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Liqin Zhao
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Longfei Wang
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Ziwei Liang
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Xiaojie Lian
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Weiyi Chen
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
| | - Jiucun Wang
- Human Phenome Institute, Fudan University, Shanghai, 200433, P. R. China
- Greater Bay Area Institute of Precision Medicine (Guangzhou), School of Life Science, Fudan University, Shanghai, 200433, P. R. China
| | - Zhaoyan Yu
- Shandong Public Health Clinical Center, Shandong University, Jinan, 250000, P. R. China
| | - Xudong Ma
- Cytori Therapeutics LLC, Shanghai, 201802, P. R. China
| | - Di Huang
- Department of Biomedical Engineering, Research Center for Nano-biomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, P. R. China
- Research Center for Biomaterials, Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan, 030032, P. R. China
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7
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Atila D, Kumaravel V. Advances in antimicrobial hydrogels for dental tissue engineering: regenerative strategies for endodontics and periodontics. Biomater Sci 2023; 11:6711-6747. [PMID: 37656064 DOI: 10.1039/d3bm00719g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Dental tissue infections have been affecting millions of patients globally leading to pain, severe tissue damage, or even tooth loss. Commercial sterilizers may not be adequate to prevent frequent dental infections. Antimicrobial hydrogels have been introduced as an effective therapeutic strategy for endodontics and periodontics since they have the capability of imitating the native extracellular matrix of soft tissues. Hydrogel networks are considered excellent drug delivery platforms due to their high-water retention capacity. In this regard, drugs or nanoparticles can be incorporated into the hydrogels to endow antimicrobial properties as well as to improve their regenerative potential, once biocompatibility criteria are met avoiding high dosages. Herein, novel antimicrobial hydrogel formulations were discussed for the first time in the scope of endodontics and periodontics. Such hydrogels seem outstanding candidates especially when designed not only as simple volume fillers but also as smart biomaterials with condition-specific adaptability within the dynamic microenvironment of the defect site. Multifunctional hydrogels play a pivotal role against infections, inflammation, oxidative stress, etc. along the way of dental regeneration. Modern techniques (e.g., 3D and 4D-printing) hold promise to develop the next generation of antimicrobial hydrogels together with their limitations such as infeasibility of implantation.
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Affiliation(s)
- Deniz Atila
- International Centre for Research on Innovative Biobased Materials (ICRI-BioM) - International Research Agenda, Lodz University of Technology, Żeromskiego 116, 90-924, Lodz, Poland.
| | - Vignesh Kumaravel
- International Centre for Research on Innovative Biobased Materials (ICRI-BioM) - International Research Agenda, Lodz University of Technology, Żeromskiego 116, 90-924, Lodz, Poland.
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8
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Sebők C, Tráj P, Mackei M, Márton RA, Vörösházi J, Kemény Á, Neogrády Z, Mátis G. Modulation of the immune response by the host defense peptide IDR-1002 in chicken hepatic cell culture. Sci Rep 2023; 13:14530. [PMID: 37666888 PMCID: PMC10477227 DOI: 10.1038/s41598-023-41707-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
IDR-1002, a synthetic host defense peptide (HDP), appears to be a potential candidate for the treatment of bacterial infections and the consequent inflammatory response due to its potent immunomodulatory activity. This is of relevance to the emerging issue of antimicrobial resistance in the farming sector. In this study, the effects of IDR-1002 were investigated on a chicken hepatocyte‒non-parenchymal cell co-culture, and the results revealed that IDR-1002 had complex effects on the regulation of the hepatic innate immunity. IDR-1002 increased the levels of both RANTES (Regulated on Activation, Normal T cell Expressed and Secreted) and Macrophage colony stimulating factor (M-CSF), suggesting the peptide plays a role in the modulation of macrophage differentiation, also reflected by the reduced concentrations of interleukin (IL)-6 and IL-10. The pro-inflammatory cytokine release triggered by the bacterial cell wall component lipoteichoic acid (LTA) was ameliorated by the concomitantly applied IDR-1002 based on the levels of IL-6, chicken chemotactic and angiogenic factor (CXCLi2) and interferon (IFN)-γ. Moreover, the production of nuclear factor erythroid 2-related factor 2 (Nrf2), an essential transcription factor in the antioxidant defense pathway, was increased after IDR-1002 exposure, while protein carbonyl (PC) levels were also elevated. These findings suggest that IDR-1002 affects the interplay of the cellular immune response and redox homeostasis, thus the peptide represents a promising tool in the treatment of bacterially induced inflammation in chickens.
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Affiliation(s)
- Csilla Sebők
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary.
| | - Patrik Tráj
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary
| | - Máté Mackei
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary
| | - Rege Anna Márton
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary
| | - Júlia Vörösházi
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary
| | - Ágnes Kemény
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Szigeti u. 12, 7624, Pécs, Hungary
- Department of Medical Biology, Faculty of Medicine, University of Pécs, Szigeti u. 12, 7624, Pécs, Hungary
| | - Zsuzsanna Neogrády
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary
| | - Gábor Mátis
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2, 1078, Budapest, Hungary
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9
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Duncan HF, Kobayashi Y, Kearney M, Shimizu E. Epigenetic therapeutics in dental pulp treatment: Hopes, challenges and concerns for the development of next-generation biomaterials. Bioact Mater 2023; 27:574-593. [PMID: 37213443 PMCID: PMC10199232 DOI: 10.1016/j.bioactmat.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
This opinion-led review paper highlights the need for novel translational research in vital-pulp-treatment (VPT), but also discusses the challenges in translating evidence to clinics. Traditional dentistry is expensive, invasive and relies on an outmoded mechanical understanding of dental disease, rather than employing a biological perspective that harnesses cell activity and the regenerative-capacity. Recent research has focussed on developing minimally-invasive biologically-based 'fillings' that preserve the dental pulp; research that is shifting the paradigm from expensive high-technology dentistry, with high failure rates, to smart restorations targeted at biological processes. Current VPTs promote repair by recruiting odontoblast-like cells in a material-dependent process. Therefore, exciting opportunities exist for development of next-generation biomaterials targeted at regenerative processes in the dentin-pulp complex. This article analyses recent research using pharmacological-inhibitors to therapeutically-target histone-deacetylase (HDAC) enzymes in dental-pulp-cells (DPCs) that stimulate pro-regenerative effects with limited loss of viability. Consequently, HDAC-inhibitors have the potential to enhance biomaterial-driven tissue responses at low concentration by influencing the cellular processes with minimal side-effects, providing an opportunity to develop a topically-placed, inexpensive bio-inductive pulp-capping material. Despite positive results, clinical translation of these innovations requires enterprise to counteract regulatory obstacles, dental-industry priorities and to develop strong academic/industry partnerships. The aim of this opinion-led review paper is to discuss the potential role of therapeutically-targeting epigenetic modifications as part of a topical VPT strategy in the treatment of the damaged dental pulp, while considering the next steps, material considerations, challenges and future for the clinical development of epigenetic therapeutics or other 'smart' restorations in VPT.
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Affiliation(s)
- Henry F. Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Lincoln Place, Dublin, Ireland
| | - Yoshifumi Kobayashi
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Michaela Kearney
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Lincoln Place, Dublin, Ireland
| | - Emi Shimizu
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
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10
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Li Y, Bi D, Hu Z, Yang Y, Liu Y, Leung WK. Hydrogel-Forming Microneedles with Applications in Oral Diseases Management. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4805. [PMID: 37445119 DOI: 10.3390/ma16134805] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Controlled drug delivery in the oral cavity poses challenges such as bacterial contamination, saliva dilution, and inactivation by salivary enzymes upon ingestion. Microneedles offer a location-specific, minimally invasive, and retentive approach. Hydrogel-forming microneedles (HFMs) have emerged for dental diagnostics and therapeutics. HFMs penetrate the stratum corneum, undergo swelling upon contact, secure attachment, and enable sustained transdermal or transmucosal drug delivery. Commonly employed polymers such as polyvinyl alcohol (PVA) and polyvinyl pyrrolidone are crosslinked with tartaric acid or its derivatives while incorporating therapeutic agents. Microneedle patches provide suture-free and painless drug delivery to keratinized or non-keratinized mucosa, facilitating site-specific treatment and patient compliance. This review comprehensively discusses HFMs' applications in dentistry such as local anesthesia, oral ulcer management, periodontal treatment, etc., encompassing animal experiments, clinical trials, and their fundamental impact and limitations, for example, restricted drug carrying capacity and, until now, a low number of dental clinical trial reports. The review explores the advantages and future perspectives of HFMs for oral drug delivery.
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Affiliation(s)
- Yuqing Li
- Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Duohang Bi
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Zhekai Hu
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yanqi Yang
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yijing Liu
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wai Keung Leung
- Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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11
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Etayash H, Yip F, Hancock REW. Impacts of PEGylation and Glycosylation on the Biological Properties of Host Defense Peptide IDR1018. Pharmaceutics 2023; 15:pharmaceutics15051391. [PMID: 37242633 DOI: 10.3390/pharmaceutics15051391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
The multifunctional properties of host defense peptides (HDPs) make them promising drug candidates to tackle bacterial infections and tissue inflammation. However, these peptides tend to aggregate and can harm host cells at high doses, potentially limiting their clinical use and applications. In this study, we explored the influences of both pegylation and glycosylation on the biocompatibility and biological properties of HDPs, particularly the innate defense regulator IDR1018. Two peptide conjugates were designed by attaching either polyethylene glycol (PEG6) or a glucose moiety to the peptide towards the N-terminus. Significantly, both derivatives reduced the aggregation, hemolysis, and cytotoxicity of the parent peptide by orders of magnitude. In addition, while the pegylated conjugate, PEG6-IDR1018, retained an excellent immunomodulatory profile, similar to that observed for IDR1018 itself, the glycosylated conjugate, Glc-IDR1018, significantly outperformed the parent peptide in inducing anti-inflammatory mediators, MCP1 and IL-1RA and in suppressing the level of lipopolysaccharide-induced proinflammatory cytokine IL-1β. Conversely, the conjugates led to a partial reduction in antimicrobial and antibiofilm activity. These findings underline the impacts of both pegylation and glycosylation on the biological properties of the HDP IDR1018 and indicate the potential of glycosylation to enhance the design of highly effective immunomodulatory peptides.
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Affiliation(s)
- Hashem Etayash
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, 2259 Lower Mall Research Station, Vancouver, BC V6T 1Z4, Canada
| | - Fione Yip
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, 2259 Lower Mall Research Station, Vancouver, BC V6T 1Z4, Canada
| | - Robert E W Hancock
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, 2259 Lower Mall Research Station, Vancouver, BC V6T 1Z4, Canada
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12
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Liang H, Wang Z, Wu J, Li X, Semirumi DT. Microstructural and micromechanical modeling of gum-gelatin-based soft tissue engineering scaffolds. Int J Biol Macromol 2023; 241:124544. [PMID: 37086767 DOI: 10.1016/j.ijbiomac.2023.124544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
Oral and dental diseases, including periodontal disease, are among the most common conditions in the field of dentistry. The best treatment for this complication is the use of different polymers and multi-component biological tissue prepared through the freeze-drying technique. In this study, biocompatible and biodegradable polymers, namely polyvinyl alcohol (PVA) and gelatin (GN), were used for this purpose, along with Arabian gum-hydroxyapatite (HA) for its antibacterial properties. Arabian gum, with weight percentages of 0, 2, 4, and 6 wt%, was added to the polyvinyl alcohol-gelatin composition at -55 °C for 28 h in the freezer and 48 h at -45 °C under a pressure of 0.01 mbar. The resulting porous biological tissue, with four different ratios, was tested for mechanical and biological analysis in a physiological solution. Then, the samples were analyzed using a scanning electron microscope (SEM) and X-ray diffraction (XRD) technique to study the morphology and structure of the compounds before and after placement in biological solutions. Additionally, a wettability and antibacterial test were performed on the nanocomposite specimen. The SEM observations revealed that this method can create a porous structure with a porosity of about 30-50 μm with a spherical and circular architecture, which was further improved by the addition of gum, reducing the percentage of porosity and improving the tissue's tensile strength and elastic modulus. The porosity changes showed a decrease from 72 % to 60 %, and the tensile strength increased from 53.5 KPa to 76 KPa, resulting in an elastic modulus of 510 KPa to 800 KPa. The addition of gum also reduced the rate of destruction of the biological tissue, making it more suitable for soft tissue applications. The obtained results of the pH test showed that the concentration changes were neutral. The contact angle of water droplets was measured to determine hydrophilicity, indicating an improvement in hydrophilicity after the addition of gum. The results showed that the use of PVA and gelatin, due to their ductility and suitable mechanical properties, along with Arabian gum-HA, could accelerate the healing process of dental periodontal problems.
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Affiliation(s)
- Huixing Liang
- School of Marine and Bioengineering, Yancheng Institute of Technology, Yancheng 224051, China.
| | - Ziming Wang
- School of Mechanical Engineering, Yancheng Institute of Technology, Yancheng 224051, China
| | - Junsong Wu
- Department of Basic Medical Science, Jiangsu Vocational Collere of Medicine, Yancheng 224000, China
| | - Xiang Li
- School of Marine and Biological Engineering, Yancheng Teachers University, Yancheng 224005, China.
| | - D T Semirumi
- School of Marine and Bioengineering, Yancheng Institute of Technology, Yancheng 224051, China
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13
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Chu W, Ma Y, Zhang Y, Cao X, Shi Z, Liu Y, Ding X. Significantly improved antifouling capability of silicone rubber surfaces by covalently bonded acrylated agarose towards biomedical applications. Colloids Surf B Biointerfaces 2023; 222:112979. [PMID: 36435025 DOI: 10.1016/j.colsurfb.2022.112979] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
Bacteria have the extraordinary ability to adhere to biomaterial surfaces and form multicellular structures known as biofilms, which have a detrimental impact on the performance of medical devices. Herein, an investigation highlighted the effective inhibition of bacteria adhesion and overgrowth on silicone rubber surface by grafting polysaccharide, agarose (AG), to construct hydrophilic and negatively charged surfaces. Because of the strong hydration capacity of agarose, the water contact angle of the modified silicone rubber surfaces was significantly reduced from 107.6 ± 2.7° to 19.3 ± 2.6°, which successfully limited bacterial adherence. Most importantly, the durability and stability of coating were observed after 10 days of simulated dynamic microenvironment in vivo, exhibiting a long service life. This modification method did not compromise biocompatibility of silicone rubber, opening a door to new applications for silicone rubber in the field of biomedical materials.
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Affiliation(s)
- Wenting Chu
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China
| | - Yuhong Ma
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China
| | - Yuning Zhang
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China
| | - Xinjie Cao
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China
| | - Zhongyu Shi
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China
| | - Ying Liu
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China
| | - Xuejia Ding
- Key Laboratory of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, China; Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, China.
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Towards a New Concept of Regenerative Endodontics Based on Mesenchymal Stem Cell-Derived Secretomes Products. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010004. [PMID: 36671576 PMCID: PMC9854964 DOI: 10.3390/bioengineering10010004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
The teeth, made up of hard and soft tissues, represent complex functioning structures of the oral cavity, which are frequently affected by processes that cause structural damage that can lead to their loss. Currently, replacement therapy such as endodontics or implants, restore structural defects but do not perform any biological function, such as restoring blood and nerve supplies. In the search for alternatives to regenerate the dental pulp, two alternative regenerative endodontic procedures (REP) have been proposed: (I) cell-free REP (based in revascularization and homing induction to remaining dental pulp stem cells (DPSC) and even stem cells from apical papilla (SCAP) and (II) cell-based REP (with exogenous cell transplantation). Regarding the last topic, we show several limitations with these procedures and therefore, we propose a novel regenerative approach in order to revitalize the pulp and thus restore homeostatic functions to the dentin-pulp complex. Due to their multifactorial biological effects, the use of mesenchymal stem cells (MSC)-derived secretome from non-dental sources could be considered as inducers of DPSC and SCAP to completely regenerate the dental pulp. In partial pulp damage, appropriate stimulate DPSC by MSC-derived secretome could contribute to formation and also to restore the vasculature and nerves of the dental pulp.
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Chu T, Li Q, Dai C, Li X, Kong X, Fan Y, Yin H, Ge J. A novel Nanocellulose-Gelatin-AS-IV external stent resists EndMT by activating autophagy to prevent restenosis of grafts. Bioact Mater 2022; 22:466-481. [PMID: 36330163 PMCID: PMC9615139 DOI: 10.1016/j.bioactmat.2022.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Vein grafts are widely used for coronary artery bypass grafting and hemodialysis access, but restenosis remains the "Achilles' heel" of these treatments. An extravascular stent is one wrapped around the vein graft and provides mechanical strength; it can buffer high arterial pressure and secondary vascular dilation of the vein to prevent restenosis. In this study, we developed a novel Nanocellulose-gelatin hydrogel, loaded with the drug Astragaloside IV (AS-IV) as an extravascular scaffold to investigate its ability to reduce restenosis. We found that the excellent physical and chemical properties of the drug AS-IV loaded Nanocellulose-gelatin hydrogel external stent limit graft vein expansion and make the stent biocompatible. We also found it can prevent restenosis by resisting endothelial-to-mesenchymal transition (EndMT) in vitro. It does so by activating autophagy, and AS-IV can enhance this effect both in vivo and in vitro. This study has added to existing research on the mechanism of extravascular stents in preventing restenosis of grafted veins. Furthermore, we have developed a novel extravascular stent for the prevention and treatment of restenosis. This will help optimize the clinical treatment plan of external stents and improve the prognosis in patients with vein grafts. The NC-Gelatin extravascular stent has suitable physicochemical properties to prevent restenosis of the grafted veins. The NC-Gelatin extravascular stent has excellent biocompatibility, which is critical for grafting veins. The NC-Gelatin extravascular stent prevents restenosis by activating autophagy against EndMT. AS-IV can enhance the effect of the stent to activate autophagy against EndMT.
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Affiliation(s)
- Tianshu Chu
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Qingye Li
- College of Food Science, Sichuan Agricultural University, No.46, Xin Kang Road, Yaan, Sichuan Province, 625014, PR China
| | - Chun Dai
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Xiang Li
- CAS Key Laboratory of Soft Matter Chemistry, Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui, 230026, China
| | - Xiang Kong
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Yangming Fan
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China
| | - Hongyan Yin
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jianjun Ge
- Department of Cardiac Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China,Anhui Provincial Engineering Research Center for Cardiopulmonary and Vascular Materials, Hefei, Anhui, 230001, China,Corresponding author. The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China.
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